‘Advance Care Planning Consultation

1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–

(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–

(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that–

(I) ensures such orders are standardized and uniquely identifiable throughout the State;

(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

(2) A practitioner described in this paragraph is–

(A) a physician (as defined in subsection (r)(1)); and

(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that–

(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items–

(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

(iii) the use of antibiotics; andCommentsClose

(iv) the use of artificially administered nutrition and hydration.’.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ‘(2)(FF),’ after ‘(2)(EE),’.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended–

(A) in paragraph (1)–

(i) in subparagraph (N), by striking ‘and’ at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and

(iii) by adding at the end the following new subparagraph:

(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’; and

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

‘(3) Physician’S QUALITY REPORTING INITIATIVE-Comments

‘(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

‘(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.

(c) Inclusion of Information in Medicare & You Handbook-

(1) MEDICARE & YOU HANDBOOK-

(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including–

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including–

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.)

As to “Why are we talking about living wills?” – because that’s what the provision in the proposed ‘health care reform’ bill covered – reimbursing doctors for time spent counseling elderly patients about living wills. That’s the provision that was cited as creating ‘death panels’. (Go ahead, look it up. I’m done doing your homework for you.)

Maddow pointed out that the identical concept that Limbaugh, Gingrich, and Palin decried when the Obama administration proposed it was all hunky dory when they and their GOP fellow-travellers were proposing it.

Either they’re lying about ‘death panels’ following inevitably from such a provision, or they are lying about opposing death panels. Not really a third option, I’m afraid. Personally, I figure it’s the former, though you might disagree, I suppose.

Palin’s “proclamation” was on the money. Using a rhetorical device to make a point is something you, sir, are well acquainted with. Particularly if it is hyperbolic.

What I think of Maddow’s tone, or whether or not I like her is irrelevant. She is an intellectual wasteland. She has no redeeming qualities, nothing to recommend her to a TV or radio show of her own.

Nothing that comes from her, factual or not, is worth heeding. Michael Vick may be a nice guy, but I’ll pass on his opinions on proper pet care, thank you.

204 GOP House members and 42 GOP Senators have not been talking about death panels, then or now. I suspect few of them even knew that the provision was in the legislation.

“…these people were for living wills before they were against them.” What? WHAT? What are you talking about? Why are we talking about living wills?

What is it that makes you tick, Mr. Ingles? Do you have to win the argument, even when none exists? I made a rather simple, non-controversial, tongue in cheek comment that Maddow is “truly an objective, non-partisan commentator.” And now we have come to the point of realizing that none of what she brought up (if we assume that she even got the contexts right) is even relevant.

So what gives?

(BTW… go ahead and read the link to “swampland”. Limbaugh doesn’t figure in that article at all. “204 GOP House members and 42 GOP Senators” do, though. I’m pretty sure they’re both Republican and elected. When I said “there’s more where that came from”, I wasn’t referring to Rush – I was referring to more people than just Rush displaying such hypocrisy.)

As to Maddow – Fine, if it makes you happy, we’ll happily stipulate that she’s not objective. But… so what? Did she fake the video of Limbaugh advocating living wills? (I’d have to call that ‘going on record’, but perhaps you know of an obscure usage of the term I’m unfamiliar with.) Did she fake Palin’s proclamation? (Will you trust the State of Alaska if they tell you the sky’s blue?)

You don’t have to like her tone. You don’t have to like what she points out in that clip. But you don’t get to ignore the actual facts she points out – such as that these people were for living wills before they were against them. That would be as bad as me ignoring when Rush points out actual facts.

There have been 46 posts on this thread, covering a multitude of topics. You brought in a bitter partisan in support of (?), well, you never really said. I challenged the objectivity of your source.

You can make the topic anything you like, but me questioning your use of a left-wing loon as a source is perfectly acceptable. I wouldn’t trust her if she told me the sky was blue.

Rush Limbaugh can speak for himself. He is on the radio three hours a day and says a lot of things about a lot of subjects. My guess is that you rarely, if ever, listen to him. Your ignorance of his positions is obvious, and merit no further discussion.

Far from having a “gotcha,” you don’t have any idea what Rush has said or what he believes. Your link to swampland is irrelevent, since Rush is not elected, he is not a Republican, and is not on record as having supported end-of-life counseling.

Here we go around again. Pretty soon you will have the issue all contorted and twisted into something entirely unrecognizable. That is your track record.

Noting inconsistencies in the rhetoric of the people making the accusations of “death panels” is fully in line with that. (And there’s more where that came from: http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/ ) Is Maddow wrong that these people are misrepresenting the contents of the bill, their own views, or both? Do you care to address that? Even if I agreed that Maddow and Limbaugh are biased and partisan – that still doesn’t mean either is automatically wrong.

Besides, if we did decide to accept your change of topic – you made no case for your assertion, so why should I have to make a case for a counter-assertion? I was just taking you at your word, illustrating the strength of your own ‘argument’…

Excuse me, but this is EXACTLY what we were talking about.

My comment in 39: “Oh, yes, Rachel Maddow. Truly an objective, non-partisan commentator.” Your response in 41: “Is so!” My response to you in 42: “If you will admit that Rush Limbaugh is fair and impartial, I will do the same with Maddow.”

Maddow is not objective, she is a harsh partisan, and we have not discussed whether or not she is correct on this issue. It is not the issue.

Once again, Mr. Ingles, you offer a link with no comment and then want to dispute issues that have not been offered.

Do you still not see why people call you dishonest? Still?

As C.S. Lewis put it, “You must show that a man is wrong before you start explaining why he is wrong.” (I think he’d be willing to extend that to women, too.) All you need to do is explain why Maddow is wrong, and then you won’t have to call her “partisan” or “partial”.

The topic of how can a conservative also be an atheist has been raised here. A good example is an article in today’s American Thinker called “Extort thy Neighbor…”

Here are two excerpts that show the common ground between conservatives and Ayn Rand atheists. The “Jack” referred to is not myself.

Quote 1:

Who can tell me why when Jack’s friend visits, it is extortion, and when the government agent visits it isn’t? No one can, because logically there is no difference. Ayn Rand in fact gives a slight moral edge to Jack’s friend (from Collectivized Ethics in The Virtue of Selfishness):

In fact, the private hoodlum has a slight edge of moral superiority: he has no power to devastate an entire nation and his victims are not legally disarmed.

Who are the villains here?

Number one are the voters who choose politicians who will extort money for them from their neighbors. “Fair share of the rich” to these voters means they will be getting some of that money, with visions of free stuff dancing in their heads.

Quote 2

America has not been free, prosperous, and economically strong by magic. No other-worldly force guarantees us a high standard of living. We are economically strong only because our people have been free to pursue their own wealth. This year there are numerous examples of businesses not expanding or hiring because of an anti-business administration. History is full of examples of the failure of collectivized schemes, including the miserable failure of the initial communal structure at Jamestown.

If you will admit that Rush Limbaugh is fair and impartial, I will do the same with Maddow.

It is not controversial to assert that Maddow is a hard leftist. She has said as much.

By the way, your post 38 contains no commentary or justification for Maddow’s presentation, except an implied approval.

Is not.